Streetsblog Capitol Hill

“A leading voice for better urban design for the sake of good health.” “A public health/social justice hero.” Dr. Richard Jackson, chair of environmental health at UCLA, is a leading voice for transportation reform whose work has linked America’s sprawl to the nation’s high rates of obesity.

The former director of the Center for Disease Control’s Environment Health Department will take to the airwaves Tuesday in an interview with PBS’s Tavis Smiley. The interview will run in coordination with Dr. Jackson’s four-hour documentary series, Designing Healthy Communities (check local listings).

Dr. Jackson spent years researching public health epidemics and zeroed in on car dependence and sprawl as leading factors in America’s diabetes and obesity epidemics.

“We have built America in a way that is, I believe, is fundamentally unhealthy,” Dr. Jackson says. “It prevents us from walking. It inhibits us from socializing. It removes trees and the things that make our air quality better. We could not have designed an environment that is more difficult for people’s well being at this point.”

He adds: “Two percent of the United States’ gross domestic product goes to the treatment of diabetes. This is a crushing economic impact.”

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Check out these two maps, the first showing obesity rates (by county) in the United States and the second showing the percentage of commuters who travel by car (via Planetizen).

Researchers Anne Price and Ariel Godwin at Planetizen caution readers not to conflate correlation and causation. However, when comparing other economic and demographic characteristics (unemployment, educational attainment, income), no other maps displayed such striking similarities.

Furthermore, when the research team created a scatterplot comparing obesity rates in U.S. counties with commuting patterns, a “strong relationship” emerged.

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Gerontologists in a laboratory at the University of Southern California exposed a group of mice to the same atmospheric conditions that humans encounter when driving along the freeway. Horrifyingly, they discovered that the mice’s brains showed the kind of swelling and inflammation associated with diseases such as Alzheimer’s. The researchers didn’t super-dose to get these results: the mice were exposed to freeway air for the equivalent of 15 hours a week — less than the 18.5 hour average Americans spend in their cars. Jokes aside about getting those darn mice off the road, the study suggests that driving less can reduce our risk of brain damage.

For decades, Americans have been hearing about the dangers of air pollution, much of which derives from our fleet of vehicles. Yet as the body of research has grown, clarifying just how damaging automobiles are to human health and the environment, we’ve persisted in spending an astounding amount of time in cars. As a nation, we drove three trillion miles last year. We have developed responses designed to treat symptoms of the underlying ailment, like keeping children indoors when the local ozone level triggers “code red” or “code purple” alerts. But as a whole, we have not responded to the everyday contamination of our bodies by driving less.

Most of us feel powerless to affect air quality. Many feel trapped by the built environment and unable to cut down on driving. Plenty also see no point in changing their behavior when “everyone else” is going to drive as much as they wish to. It’s unsurprising then that news about pollution is brushed aside—as is news about other ills caused by driving, including crash fatalities and injuries, stress, and obesity.

The UCLA mouse study joined other recent reports that highlight the variety of ways in which remaining overly reliant on the private automobile is self-destructive. But these reports should also make clear that changes in individual behavior can alleviate some of the problems. Here’s just a sampling:

• Sitting for long stretches greatly increases the risk of heart disease – even if you exercise afterwards – according to a study in the Journal of the American College of Cardiology. It may come as no surprise that sitting isn’t good for your health, but what’s shocking is that the raft of articles following the study tended to ignore active transportation while advocating improbable solutions such as standing treadmill desks. What’s more practical than replacing some of our long hours planted in the driver’s seat with walking, biking, or getting by foot to public transit stops?
• While there was some good news in the American Lung Association’s 2011 State of the Air Report, as one commentator put it, it was “like getting a 53 on your math test after you got a 49 on your last one.” Half of Americans live in areas in which air quality is unhealthy. The ALA points out that the elderly, the young, and the sick are most vulnerable to the effects of pollution. And of course some of the sick—such as those suffering from asthma and heart disease—can trace the very causes of their conditions to air pollution.

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Dr. Richard J. Jackson is Professor and Chair of Environmental Health Science in the UCLA School of Public Health. We’re happy to host opinion pieces from academic and other community leaders. Contact damien@streetsblog.org if you’re interested.

On February 23, Senator Barbara Boxer and Representative John Mica held a congressional hearing here in Los Angeles to discuss the federal transportation bill. The dominant theme of the hearing was expanding and establishing federal financing programs to provide capital for major infrastructure projects such as Los Angeles’s 30/10 plan, an initiative to build 12 major transit projects in 10 years. The elected leaders and assembled experts lauded the proposed programs for their potential to rapidly stimulate job creation and economic growth. Very little was mentioned, however, about the need for transportation investments to also be guided by other objectives, such as reducing air pollution, investing in biking and walking networks, and improving safety – all critical elements for improving the economy and public health. Transportation has immense impacts on human health, both positive and negative. Current policies fail to consider and value these impacts, but they must.

Traditionally, federal transportation funds have been given to states according to formula and with little accountability for how they are used. In Los Angeles the results are staggering. The annual health impacts from air pollution in our region alone are conservatively estimated at $22 billion, or $1,250 per person per year. Also, while pedestrians or cyclists account for 12 percent of all trips, they suffer 25 percent of all traffic fatalities. And as we have become more dependent on cars as a way to get to our jobs, to the store, to our doctors’ offices, and to every place else, our physical activity has declined, and coronary heart disease has become the number one killer of LA County residents.

To the credit of many public health leaders, elected officials, local policymakers, and engaged citizens, cities throughout the region are investing in biking and walking infrastructure to address these issues, revitalize local economies, and increase the effectiveness of transit systems. Planners in numerous cities — including Pasadena, Long Beach, Culver City, Glendale, Santa Monica, and Los Angeles — are setting strategic long-term goals and formulating plans to expand biking and walking networks, make them safer, and integrate them into existing and future public transit networks.

California is moving forward with its SB 375 law to reduce emissions by focusing on the communities we build and the types of transportation we use. This landmark law has initiated a process where planners, regulators, and the public have come together to set long-term goals and plan to achieve them. One purpose of this law is to comprehensively evaluate how different projects — including public transit, bicycle and pedestrian infrastructure, car-pool lanes, and roads — contribute collectively to achieving these goals.

But federal transportation bills have not set these strategic goals. As a result, despite continuous increases in federal funding, public health has not been a major factor as transportation projects are selected. Los Angeles, for example, has seen its air quality improve significantly but not as a result of more public transportation or communities where people can bike and walk safely and efficiently, but rather because cars are cleaner. At the same time, sprawl has continued to increase to a point where, in Los Angeles alone, we spend 490 million hours annually stuck in traffic. The combined weight of the health impacts from air pollution, traffic accidents, and lack of physical activity along with the costs of wasted fuel and time is a collective drag on our health and economy. Read more…

It makes intuitive sense that cycling and walking to work regularly would help people stay healthy, but until now there's only been anecdotal evidence suggesting that places where walking or cycling to work is common also have lower rates of obesity.

That changed in a significant way yesterday when the American Journal of Public Health published new findings from researchers at Rutgers, Virginia Tech, and the Centers for Disease Control and Prevention (CDC) that show a clear link between high levels of walking and bicycling to work and positive health outcomes. The study was led by John Pucher, an urban planning professor at Rutgers.

The researchers analyzed health and travel data from a variety of sources, including the U.S. Census’ American Community Survey, and the CDC’s Behavioral Risk Factor Surveillance System.

Among the 50 states, obesity rates range from 19 percent to 35 percent, while rates of active commuting vary from two to nine percent.

The study found that there are significant connections between having a low obesity rate and a high rate of walking or biking to work. The same is true for diabetes. In statistical terms, about 30 percent of the variation in obesity among states -- and more than half of the variation in diabetes -- was linked to differences in walking and cycling rates.

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A new report written by the Victoria Transport Policy Institute's Todd Litman for the American Public Transit Association [PDF], the trade organization for the nation's transit agencies, reminds us that one of the most valuable benefits of transit is to our health. Summarizing the state of research in the field, "Evaluating Public Transportation Health Benefits" lays out the basic fact that increasing transit use is an easy way of preventing thousands of unnecessary deaths each year. 

The damage that our current transportation system does to our health is staggering. Each year, 40,000 Americans die in traffic crashes, according to the report, the equivalent of 1,186,070 years of life lost. Estimates attribute an equal number of deaths to motor vehicle air pollution, which tends to affect an older population. The number of deaths attributable to a third category of health impact, the sedentary lifestyle driving promotes, wasn't estimated.

Importantly, the report points out that these tens of thousands of deaths, along with a number of injuries and illnesses an order of magnitude larger, aren't the result of how we drive but of how much we drive. For example, the United States has by far the highest traffic fatality rate among its peer countries per capita, but not per mile driven (that title goes to Ireland). Americans die more because we drive more, not because we drive worse.

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Two reports released last week underscored the increasing severity of America's obesity epidemic. And the eye-opening findings add to the mounting evidence that stopping the spread of obesity and its attendant health risks will require changes to the nation’s transportation system as surely as it demands altering our diets.

A report from the Centers for Disease Control and Prevention released Tuesday showed the number of obese Americans has increased by 2.4 million since 2007. There are now nine states where more than 30 percent of the population qualifies as obese -- up from three states in 2007. (Just ten years ago, no state had obesity levels above 30 percent). 

The following day, Gallup released a ranking of the nation’s most and least obese states as part of a broader index of well-being. By its accounting, a cluster of states in the southeast -- West Virginia, Kentucky, Mississippi, Arkansas, and South Carolina -- have the highest rates of obesity, while the thinnest states, mainly in the west and New England, tend to have obesity rates about ten percentage points lower.

In the CDC ranking of states (which varies slightly from the Gallup ranking), Colorado and the District of Columbia are the only states with obesity rates under 20 percent, making their rate nearly 15 points lower than the most obese states. Their secret? During a press briefing, the CDC's Bill Dietz speculated that Colorado’s investment in biking and walking trails, as well as District residents' frequent use of public transportation, which goes hand in hand with walking and thus burns more calories than driving, are possible factors.

Indeed, if you look at rates of active commuting (walking and biking) in the most and least obese states, a revealing correlation emerges. Three of the five most obese states in the Gallup ranking are also among the five states with the smallest percentage of people who bike to work. At the other end of the spectrum, four of the ten thinnest states are among those where people bike to work most frequently. (The commuting rates come from Census data detailed in this League of American Bicyclists report.)

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Maybe you commute by train, or maybe you've switched from driving to biking. But your stuff is still traveling the country by diesel truck.

Nearly a quarter of transportation-related greenhouse gas emissions come from freight. The movement of goods from port of entry to a store near you throws enough particulate pollution into the air to shorten the lives of 21,000 people each year, according to the Clean Air Task Force.

The freight sector is lumbering under inefficient and outdated systems that cause pollution, public health problems, safety hazards, and delivery delays. There’s never been a coordinated national approach to solving these problems. And with no deliberate strategy, the default approach is often to build more highways.

As Stephen Davis of Transportation for America writes:

If a port is congested or wants to expand, there’s little available federal money to spend directly on rail or any other mode. Your choices are highways or highways. When a state or port does spend to improve operations, there is no accountability to make sure they’re actually reducing port/freight congestion, moving freight faster, or reducing air pollution in surrounding communities.

Enter the FREIGHT Act. (That’s the Focusing Resources, Economic Investment and Guidance to Help Transportation Act of 2010, with true Capitol Hill acronym panache.) The FREIGHT Act was introduced in the Senate toward the end of July and in the House a week later.

The bill focuses on areas known as "connectors," said Kathryn Phillips of the Environmental Defense Fund. “All the literature and studies say it’s the connector areas, the hubs, where you have the most congestion and environmental impacts.” The bill calls for troubleshooting at these bottlenecks, where products are transferred “from boat to truck to another truck to rail” and everything gets bogged down. Trucks get stuck in traffic; trains sit on the tracks; ships idle at port.

Communities near international ports pay the price. In Riverside, California, traffic gets tied up at 26 at-grade rail crossings 128 times a day when trains pass. Add to that the noise and pollution nearby neighborhoods must contend with.

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Transportation is a public health issue. As profiled in the recently released report from the Trust for America's Health, "F as in Fat," obesity rates continue to rise across the nation, increasing the risk of serious health problems like diabetes and hypertension. To solve the obesity epidemic, the data suggest, we need to rethink our dependence on the automobile. 

"F as in Fat" breaks out obesity numbers state by state. After glancing at their map, it seemed like transit and pedestrian-friendly states were doing better than the national average. To get more precise, we decided to compare adult obesity rates, as gathered in the report, to commuting statistics in the U.S. Census. You can download our spreadsheet here. 

The result is the scatterplot shown above, which clearly shows that states where more people drive to work have higher obesity rates. Caveats abound -- correlation isn't causation and state-level data can obscure important patterns visible only through a closer microscope -- but the result is provocative. The two outliers are D.C. and New York State; they imply that while a large shift away from driving can make a big difference, it can't solve the obesity crisis on its own.

Although "F as in Fat" doesn't analyze transportation behavior itself, the authors agree that moving away from a reliance on the automobile is a critical component in curbing obesity. Their recommendations include: passing legislation supporting non-motorized transportation, such as an expansion of the Safe Routes to School program or a national complete streets bill; building more safe pedestrian space and bike paths to encourage active transport; and supporting mixed-use, walkable, and transit-oriented development.

The nation's transportation planning process fails to account for more than $200 billion per year in "hidden health costs" imposed by traffic and air pollution, according to a new report from the American Public Health Association (APHA) that maps the nexus between infrastructure and health care.

The APHA's report (available for download here) echoes many of the policy recommendations issued by the Centers for Disease Control last month: stronger incentives to expand bicycle and pedestrian networks, as well as more frequent measurement of the health impacts of new transport projects.

But the APHA, a trade association representing public health workers, went further than the government by adding up the estimated costs imposed by the absence of any mandatory evaluation of the health consequences of transportation decisions.

Citing U.S. DOT and American Automobile Association studies, respectively, the APHA pegged the annual price of congested roads at between $50 billion and $80 billion, with the health toll of traffic crashes -- including the treatment of fatalities, the resulting court costs, and lost wages -- reaching $180 billion per year.

The majority of those bills are paid indirectly by the transportation system users they affect, not factored in advance into local planning, as the APHA writes:

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